Welcome to Mt. San Jacinto College Counseling Department!

We are very pleased that you have chosen MSJC to provide you with the educational preparation you seek. We wish to provide you with the exact services you need that will help you to become the most successful student you can be.

Directions: Please take your time to carefully complete this intake form. Neatly print your name, and other personal contact information.

S MSJC ID#:

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Name:

Cell Phone Number: ( ) / - / Telephone Number: ( ) / -

REASON FOR APPOINTMENT

*1. Why have you come to the Counseling Department today?

Veteran Request for Educational Plan Graduation Check Probation/Disqualification
Financial Aid Request for Educational Plan Change Major Semester By Semester Plan
Transcript Evaluation Request On Track to Transfer Student Education Plan
Personal In-Class Advisement Educational Plan Nursing Major
Science, Technology, Engineering, Mathematics Majors Honors Other______

2. List at least 3 specific questions that need answers on the day of the counselor appointment.

A.  ______
B.  ______
C.  ______
3. What is your program of study (major)? ¨ Undecided Major
/ ¨ No
4. Which of the following do you want to complete? (PLEASE CHECK ALL THAT APPLY)
A degree at Mt. San Jacinto College (AA/AS)? / ¨ Yes / ¨ No
A certificate (short-term job training) at Mt. San Jacinto College? / ¨ Yes / ¨ No
Transfer to a University? ¨ / Yes / ¨ No
If you plan to transfer, list the University(s) you would like to attend.
______
Names of colleges or Universities
5. If you can do whatever you wanted and get paid for it what would you do?

STUDENT EDUCATIONAL STATUS

6. Please list ALL colleges/universities, including Mt. San Jacinto College, that you have attended and the number of estimated units you have completed. (YOU MAY ESTIMATE THE UNITS)
Mt. San Jacinto College ______
Name of other college or university units completed Name of other college or university units completed
______
Name of other college or university units completed Name of other college or university units completed
7. Have you requested to have all previous college or university official transcripts sent to MSJC
Enrollment Services? / ¨ Not Applicable
¨ Yes / ¨ No
*8. Have you completed a college degree? (AA/AS, BA/BS, MA/MS, etc) / ¨ Yes / ¨ No
9. If you completed Advanced Placement (AP) or International Baccalaureate (IB) college credit courses while in high school, what scores did you receive? / ¨ Not Applicable
AP ¨ 3 ¨ 4 ¨ 5
IB ¨ 5 ¨ 6 ¨ 7

*Front Desk Questions

T.Somers 3.25.2014